Monday 15 July 2013 15.54 EDT
First published on Monday 15 July 2013 15.54 EDT

Talk of 14 trusts with the highest mortality rates in the country and 13,000 needless deaths in the past eight years will have whetted expectations for a damning review from Sir Bruce Keogh that will show mayhem and misconduct in the NHS. But once the rhetoric from political quarters has died down, the reality may look a little different.

The 14 trusts were chosen for review because of their high death rates – but that was just the trigger. Keogh and his team have not sought to find out why the deaths occurred. There will be no public inquest and families who suspect a relative had poor care and should not have died will be disappointed.

The review has not looked at how things were but at how things are – whether each hospital or group of hospitals in a trust is performing well and where the strengths and weaknesses lie. Many people who have an inside track say that a similar pattern of good, bad and indifferent care could be found at any 14 trusts in England.

The review was a political response to publication of the Francis inquiry report into failings at Mid-Staffordshire NHS Foundation trust, which was a damning verdict on hospital care. The health secretary, Jeremy Hunt, demanded an immediate investigation into hospitals which, like Mid Staffs, had high death rates. But although mortality can flag up problems, it is rarely by itself an indictment of a whole hospital.

It is clear even from the data packs that NHS England has published on its website that the areas of potential concern are different for each trust. Take Basildon and Thurrock, which is expected to come out badly from the review. The 112 excess deaths last year shown by the summary hospital-level mortality indicator (SHMI) are in non-elective admissions – which means people brought in as an emergency (and usually at the weekend). But they are not in trauma or A&E or heart surgery, where the trust does well – they are in general medicine, palliative medicine and in geriatric medicine. In other words, the biggest problems are among the elderly. Women who give birth there need not be concerned.

If you take a different measure of excess deaths, the hospital standardised mortality ratio (HSMR), Basildon is just within the acceptable range, but there are concerns over children (the trust was warned by the Care Quality Commission last November over a number of serious incidents), cardiology and again palliative medicine.

Campaigners, who have been alarmed by Basildon's poor record and whose own relatives have died, are unlikely to be satisfied by the big picture. Basildon has its own Cure the NHS started by Dan Chapple following the death of his mother from a brain haemorrhage. They and their lawyers will want to know the reasons for the estimated 544 excess deaths between April 2010 and April 2012.

There will also be hard questions to answer for Monitor, which regulates the foundation trusts, and the CQC, which inspects all hospitals and has failed to spot real issues in time and come down hard on those that do not provide better care.

But the optimists within the NHS – and there are some - hope the way the Keogh review has investigated the 14 trusts, with a depth and breadth and inclusiveness never before attempted, could be a blueprint for inspection and regulation in the future.

Nick Black, professor of health services research at the London School of Hygiene and Tropical Medicine, who was on the national advisory group, said the Keogh review showed the way forward. "I think there's every reason to understand why politicians, the media and the public must throw their hands up in horror at the mess we seem to make of assessing the quality of hospitals," he said.

There have been so many disaster stories, from Mid Staffs to Tameside, which is one of the 14, and lately Derriford in Plymouth. "There is one after another. You have to ask: can't we do this better? I think it's justified for people to say come on NHS, get your act together."

But the use of oversimplified measures by which to judge hospitals, such as mortality data alone, had caused problems, he said. It was not a valid way to judge something as complex as a hospital.

"Picking 14 hospitals on the basis of HSMR or SHMI had little justification, but having been told to do it by Number 10, I think the way the Keogh review has undertaken it gives us a format for how it may be done in the future," he said.

The review examined all the data it could find on safety, patient experience and effectiveness. Then it listened to all the views of patients, public and staff via an open-access website to which anybody could contribute. Thirdly, it carried out an impressive series of visits, some unannounced in the middle of the night, with teams representing patients and health professionals of all levels, including student nurses and junior doctors.

With unprecedented transparency, the videos of the final showdown meetings between the review team and each trust will be published on NHS Choices, along with an action plan for the future. The idea is that those who have blown the whistle on a trust can ensure their concerns have been addressed.

Black said he thought the CQC would learn from the process. "This has been a sort of pilot," he said.